Improving Nursing Home Compare for Dually Eligible Consumers

改善具有双重资格的消费者的疗养院比较

• 批准号: 8550793
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 31.75万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8550793
• 关键词: Improving; Nursing; Home; Compare; Dually

DESCRIPTION (provided by applicant): Individuals who are enrolled in both Medicare and Medicaid (often called dually eligible or "duals") have attracted increased health policy attention in recent decades due to their disproportionate use of health care services and costs. Duals are a vulnerable population as they are generally sicker than the elderly population as a whole, more likely to be in need of long-term care, more likely to receive care in low-resource neighborhoods, and are subject to misaligned and conflicting policy incentives from Medicare and Medicaid. Nursing homes are a major site of care for duals. The nursing home sector has long been a target of concern about low quality of care, and duals are often disproportionately affected by these quality problems. In 2002 the Centers for Medicare and Medicaid Services launched a public reporting initiative (Nursing Home Compare) aimed at improving quality of care for nursing home residents in part by guiding consumers to higher quality nursing homes. However, studies of consumer response to Nursing Home Compare have revealed a small and inconsistent market share response. These lukewarm effects have been disappointing and somewhat puzzling, but they may be masking substantial heterogeneity of effect-duals may be much less likely to respond to, and benefit from, Nursing Home Compare than non-duals. Our preliminary work reveals that, rather than choosing higher-quality facilities, duals have increased their propensity to be admitted to low- quality facilities under public reporting. In this mixed methods project, we propose to examine the extent to which duals have benefited (or not) from Nursing Home Compare, to assess the importance of constrained access by duals in preventing greater use of Nursing Home Compare to choose higher-quality nursing homes, to assess qualitatively the obstacles to duals' use of Nursing Home Compare such that improvements to the report cards may be explored. In particular, information about the quality of nursing homes may not be helpful if an individual 1) lives too far from a high-quality home; 2) depends on Medicaid and no Medicaid beds are available in the high-quality homes; 3) has difficulty accessing or interpreting the quality information. By assessing the relative importance of barriers to effective use of Nursing Home Compare by duals, we will identify the most promising avenues for further investment, e.g. improved usability of quality reports vs improved availability of high-quality providers. These are crucial distinctions affecting access to high-quality care fora particularly vulnerable population.

描述（由申请人提供）：同时参加 Medicare 和 Medicaid 的个人（通常称为双重资格或“双重”）已引起越来越多的健康政策关注 近几十年来，由于他们过度使用医疗保健服务和费用。双子女是弱势群体，因为他们通常比整个老年人口病情更严重，更有可能需要长期护理，更有可能在资源匮乏的社区接受护理，并且受到医疗保险和医疗补助政策不一致和相互冲突的政策激励。疗养院是照顾双子女的主要场所。疗养院行业长期以来一直是护理质量低下的关注目标，而双亲往往受到这些质量问题的影响尤为严重。 2002 年，医疗保险和医疗补助服务中心发起了一项公共报告计划（疗养院比较），旨在通过引导消费者前往更高质量的疗养院来提高疗养院居民的护理质量。然而，对消费者对疗养院比较的反应的研究表明，市场份额的反应较小且不一致。这些冷淡的效应令人失望，也有些令人费解，但它们可能掩盖了效应的显着异质性——与非双元相比，双元可能不太可能对疗养院比较做出反应并从中受益。我们的初步工作表明，双打并没有选择更高质量的设施，而是增加了 根据公开报告，他们倾向于入住低质量设施。在这个混合方法项目中，我们建议检查双打者从疗养院比较中受益（或未受益）的程度，评估双打限制访问在阻止更多使用疗养院比较来选择更高质量的疗养院方面的重要性，定性评估双打使用疗养院比较的障碍，以便探索报告卡的改进。特别是，如果个人满足以下条件，有关疗养院质量的信息可能没有帮助： 1) 居住地距离高质量住宅太远； 2) 依赖Medicaid，高品质家庭没有Medicaid床位； 3) 难以获取或解释质量信息。通过评估对偶有效使用疗养院比较的障碍的相对重要性，我们将确定最有希望的进一步投资途径，例如质量报告可用性的提高与可用性的提高 的优质供应商。这些是影响特别弱势群体获得高质量护理的关键区别。